Everything You Need To Know About Hyperpigmentation

You're washing your face one day — business as usual — and, seemingly out of the blue, you notice a weird new dark mark. Is it in the same place as that pimple of yesteryear? Did it pop up after a particularly long day in the sun this past weekend? These are all factors to consider before you even start to think about treatment. Not all dark spots are created equal — and, in turn, they should not be treated equally.

From post-inflammatory hyperpigmentation (PIH) to melasma (and every age spot in between), read ahead to get a full breakdown of the different types of hyperpigmentation, what causes them, and how you can treat them ASAP.
The Fast Facts:
After acne, hyperpigmentation is the second most popular reason people seek a dermatologist, according to Carlos A. Charles, MD, and founder of Derma di Colore (a dermatology practice in New York City). While hyperpigmentation is a fairly broad term, the basic definition is an increase in melanin that produces pigment in the skin (we'll get to why shortly). People with more melanin have more robust melanocytes, and are able to produce more pigment —which is why those with dark skin often have more dark spots, explains Dr. Charles.

PIH
PIH is the most frequent type of dark mark, and the one that often comes from our own doing. "PIH is the result of acne, trauma, eczema, or a rash," says Dr. Charles. When that inflammation goes away, the skin develops more melanin. The marks can pop up anywhere on your skin a few days after the injury, and are typically small, localized, and dark brown.

Melasma
Another common form of hyperpigmentation is referred to as melasma. "We don’t know exactly why people develop melasma, but we see it more commonly in women, so we think there’s a hormonal push or etiology to it," says Dr. Charles. He notes that melasma often occurs during pregnancy or when women go on birth control, which is why it's thought to be linked to estrogen levels. But, he adds, it's also seen in men, particularly those of Hispanic or Indian descent. Melasma appears as brown or gray-brown patches on the cheeks, central forehead, or upper lip area.

Age Spots
Age spots, also known as lentigos, are often caused by exposure to the sun (solar lentigos), but can also develop over time — like, wait for it, as you age. "These tend to be localized brown spots that we see on sun-exposed areas, such as the cheeks, forehead, chest, and the backs of the hands," says Dr. Charles. "They might also create a subtle change in the texture of the skin."

Birthmarks
Birthmarks, moles, and freckles are often lumped into the hyperpigmentation group, but Dr. Charles stresses that they belong to a category in and of itself, and would require a completely different treatment, if you were interested in getting rid of them at all.
Treating Your Spots
You can see products formulated to "Fade! Lighten! Brighten!" dark spots during every commercial break. But, things start to get confusing when brands don't specify who should be using what. "From a marketing point of view, companies keep it general so that people will buy [their products] and use them for a lot of different things," says Dr. Charles. "But, treatment should really depend on the source of the hyperpigmentation."

Getting Topical
While some derms might be quick to direct patients toward laser treatments, Dr. Charles recommends trying topical creams for PIH and less severe forms of melasma first. "I’ll start with really gentle retinoid creams," says Dr. Charles. "Then we’ll use combination products, like retinoid creams that also contain hydroquinone, and then topical medication that has retinoids, hydroquinone, and gentle steroids." Another more aggressive form of treatment is to combine both topical products and gentle chemical peels. If you want to go the over-the-counter route, Dr. Charles recommends looking for products that contain retinols and antioxidants such as vitamin C.

For age spots in particular, Dr. Charles will sometimes administer cryotherapy, which is a freezing technique that removes the top layer of the skin. While effective, he advises that this process should be done slowly and carefully, as it can end up doing a lot more harm than good.

The Lowdown On Lasers
Similarly, lasers must be approached with extreme care as certain types of hyperpigmentation can actually worsen with treatment. Melasma, specifically, is the most resistant to treatment, and can even reoccur afterward. "Even when we treat it and we’re successful, if people go out in the sun even just for five minutes without sunscreen, it can come back," notes Dr. Charles.

There's a new laser on the market that hopes to address these kinds of issues. PicoWay is a photoacoustic laser and produces less collateral thermal injury. Most notably, it can be used on all skin tones. The FDA cleared the dual wavelength laser using 1064nm, which is a deep-penetrating but safe wavelength for dark skin tones. It also uses 532nm for shallower, pigmented lesions, says Vic A. Narurkar, MD, an FAAD board-certified dermatologist who is affiliated with the brand.
Go On The Defensive
But, all of those lasers and topical treatments are null and void if you're not proactive about protecting your skin. Using sunscreen daily — at least SPF 30 — and not picking at your skin are key, says Dr. Narurkar, who recommends Elta MD UV Clear SPF 46 and SkinCeuticals Physical Fusion UV Defense SPF 50. And, if you start developing acne, seek help from your dermatologist early —it's easier to treat than the hyperpigmentation that results from scarring.

Daily sunscreen combined with topical creams — or laser treatments if you want immediate results — are a surefire way to erase those stubborn marks. If you're looking for more natural ways to treat them, we have the lowdown on that as well.


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